Provider Data Quality Auditor II (ALD)

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 55,000 - 83,000; Full time

Job summary

An established industry player is seeking a detail-oriented Provider Data Quality Auditor II to ensure the accuracy of provider network data. This role involves fostering relationships with business partners and conducting audits to maintain data integrity. The ideal candidate will thrive in a metric-driven environment, demonstrating strong analytical skills and effective communication. With a commitment to supporting low-income communities, this position offers a chance to make a meaningful impact while working in a collaborative and supportive atmosphere. Join a team dedicated to improving healthcare access for vulnerable populations in Los Angeles County.

Benefits

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Qualifications

• Minimum of 2 years of experience in healthcare or related industry.
• Strong analytical and communication skills required.

Responsibilities

• Ensure timely and accurate uploading of provider network data.
• Conduct ongoing data quality auditing and manage data fallout.

Skills

Excellent communication skills

Strong analytical skills

Ability to build strong customer relationships

Root-cause analysis

Multitasking

Education

Associate's Degree

Job description

Provider Data Quality Auditor II (ALD)

Job Category: Provider Relations

Department: Provider Data Management

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 12134

Salary Range: $55,245.00 (Min.) - $69,045.00 (Mid.) - $82,867.00 (Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time.

Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

The Provider Data Quality Auditor II is responsible for the timely and accurate uploading of L.A. Care's provider network data, including identification and remediation of provider data errors. The Provider Data Quality Auditor must foster positive working relationships with both internal and external business partners, including L.A. Care's contracted independent Practice Association (IPAs), Medical Groups, and Plan Partners. This position must make independent decisions to ensure data quality measures, timelines, and organizational policies are met related to provider network data. The position is responsible for conducting ongoing data quality auditing of L.A. Care's provider network data, including working with their assigned provider network accounts to remediate provider data errors.

Duties

1. Work in a metric-driven environment and is expected to understand and work in accordance with all department and company provider data metrics. Work with contracted partners to ensure timely, accurate, and successful submissions of all required provider data elements via the Sender Policy Framework (SPF)/Provider Add Change Delete Workflow (PCDW) tasks by continuous provider network data quality oversight and auditing activities. Must work to identify and triage all provider data quality issues.
2. Responsible to ensure that Senate Bill 137 requirements are met, by meeting mandated update periods for the provider’s name, practice location or locations, and contact information.
3. Responsible to manage and oversee all Data Fallout reporting as a result of SPF submissions from L.A. Care’s contracted entities (IPAs, Medical Groups, Plan Partners, and Vendors). Knowledgeable of reporting formats for use in continuous data auditing, independent analysis of audit results, including root-cause analysis.
4. Must be well-versed in written and verbal communications and is responsible for interacting with contracted partners and providing training and coaching activities to improve overall compliance with the SPF submission. (35%)
5. Responsible for fostering and maintaining positive working relationships with contracted partners and providing training and coaching activities to improve overall data accuracy. Must work collaboratively with Contracting and Relationship Management Account Managers to ensure that all provider data standards are met in accordance with contracts, regulations, accreditation standards, and L.A. Care Policies and Procedures, including IPA and Medical Group terminations. (15%)
6. Responsible to follow and execute appropriate procedures when administering provider data system overrides. Responsible to manage provider data quality issues for other L.A. Care business units, including but not limited to, Customer Solutions Center, Provider Services, Contracting and Relationship Management, and Facility Site Review. Responsible for understanding all data-related contracts, regulations, accreditation standards, and L.A. Care Policies and Procedures and responsible to assist and train contracted partners about this information on an as-needed basis. (20%)
7. Must have a strong knowledge of Provider Relations and an understanding of how Independent Practice or Physician Association (IPA) and Medical Groups operate. Manage data quality information for other L.A. Care business units, including but not limited to, Customer Solutions Center, Provider Services, Contracting and Relationship Management, and Facility Site Review. (15%)
8. Manage and oversee all provider data fallout, including reporting of root-cause and resolution. (5%)
9. Perform other duties as assigned. (10%)

Education Required

Associate's Degree

Experience

Required:
Minimum of at least 2 years of work experience in healthcare or related industry.
At least 2 years working with data.

Preferred:
Provider Relations, management or sales experience.
Policy and procedure and desktop manual development experience.

Skills

Required:
Excellent communication skills, strong analytical skills, and ability to build strong customer relationships, including the ability to work effectively with diverse team members.

Ability to perform root-cause analyses and recommend effective alternative solutions to handle Provider and Member inquiries, and to provide optimal customer service for internal and external customers.

Ability to multitask in a fast-paced work environment and recommend process improvement measures for day-to-day operations, wherever possible.

Physical Requirements

Light

Additional Information

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

This position is a limited duration position. The term of this position is a minimum of one year and a maximum of two years from the start date unless terminated earlier by either party. Limited duration positions are full-time positions and are eligible to receive full benefits.

L.A. Care offers a wide range of benefits including:

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program